International Society on Thrombosis and Haemostasis clinical practice guideline for treatment of congenital hemophilia A and B based on the Grading of Recommendations Assessment, Development, and Evaluation methodology.

BACKGROUND: Hemophilia is a rare congenital bleeding disorder that results from complete or partial deficiency of blood coagulation factor (F)VIII (hemophilia A) or FIX (hemophilia B) due to pathogenic variants in their coding genes. Hemophilia requires complex management. To date, there is no evidence-based clinical practice guideline on hemophilia treatment based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. OBJECTIVES: This evidence-based clinical practice guideline from the International Society on Thrombosis and Haemostasis aims to provide an overview of evidence and support patients, caregivers, hematologists, pediatricians, other clinicians, researchers, and stakeholders in treatment decisions about congenital hemophilia A and B. METHODS: The International Society on Thrombosis and Haemostasis formed a multidisciplinary guideline panel of physicians and patients with global representation, balanced to minimize potential bias from conflicts of interest. The panel prioritized a set of clinical questions and outcomes according to their importance for clinicians and patients. A methodological team supported the guideline development process, including searching for evidence and performing systematic reviews. The GRADE approach was used, including GRADE Evidence to Decision frameworks. The recommendations were subject to public comment. RESULTS: The panel selected 13 questions, of which 11 addressed the treatment of hemophilia A and 2 the treatment of hemophilia B. Specifically, the panel addressed questions on prophylactic and episodic treatment with FVIII concentrates, bypassing agents, and nonfactor therapy (emicizumab) for hemophilia A (with and without inhibitors) as well as immune tolerance induction for hemophilia A. For hemophilia B, the panel addressed questions on prophylactic and episodic treatment of bleeding events with FIX concentrates. Agreement was reached for all 13 recommendations, of which 7 (54%) were based on evidence from randomized clinical trials, 3 (23%) on observational studies, and 3 (23%) on indirect comparisons. CONCLUSION: Strong recommendations were issued for prophylactic over episodic treatment for severe and moderately severe hemophilia A and B. Only conditional recommendations were issued for the remaining questions. Future research should focus on direct treatment comparisons and the treatment of hemophilia B with and without inhibitors. Future updates of this guideline will provide an updated evidence synthesis on the current questions and focus on new FVIII and FIX concentrates, novel nonfactor therapies, and gene therapy for severe and nonsevere hemophilia A and B.

Enhancing diagnostic accuracy of multiple myeloma through ML-driven analysis of hematological slides: new dataset and identification model to support hematologists.

Multiple Myeloma (MM) is a hematological malignancy characterized by the clonal proliferation of plasma cells within the bone marrow. Diagnosing MM presents considerable challenges, involving the identification of plasma cells in cytology examinations on hematological slides. At present, this is still a time-consuming manual task and has high labor costs. These challenges have adverse implications, which rely heavily on medical professionals' expertise and experience. To tackle these challenges, we present an investigation using Artificial Intelligence, specifically a Machine Learning analysis of hematological slides with a Deep Neural Network (DNN), to support specialists during the process of diagnosing MM. In this sense, the contribution of this study is twofold: in addition to the trained model to diagnose MM, we also make available to the community a fully-curated hematological slide dataset with thousands of images of plasma cells. Taken together, the setup we established here is a framework that researchers and hospitals with limited resources can promptly use. Our contributions provide practical results that have been directly applied in the public health system in Brazil. Given the open-source nature of the project, we anticipate it will be used and extended to diagnose other malignancies.

Hematology and serum biochemistry of broilers fed diets supplemented with chondroitin and glucosamine sulfates

The objective of this study was to evaluate the hematology and serum biochemistry of broilers fed diets supplemented with chondroitin and glucosamine sulfates. An experiment was laid out in a completely randomized design with a 3 × 3 factorial arrangement (three levels of chondroitin sulfate: 0, 0.05 and 0.10%; and three levels of glucosamine sulfate: 0, 0.15, and 0.30%), with each treatment involving six replicates of 30 birds. Hematology (red blood cells, hemoglobin, hematocrit, total plasma protein [TPP], thrombocytes, white blood cells, eosinophils, monocytes, heterophils, and lymphocytes) and serum biochemistry (totalinteraction between sulfates influenced (p < 0.05) total calcium by 21 days, ionic calcium by 21 and 42 days, and phosphorus, chlorides, and sodium by 42 days. Supplementation with chondroitin and glucosamine sulfates in the broilers' diet favored their immune system and mineral metabolism, increasing serum concentrations of calcium, phosphorus, and sodium. serum protein [TSP], albumin, globulins, aspartate aminotransferase [AST], gamma-glutamyltransferase [GGT], alkaline phosphatase [AP], total calcium, ionic calcium, phosphorus, sodium, potassium, and chlorides) variables were evaluated at 21 and 42 days. Data were subjected to analysis of variance. When the means differed significantly by the F-test, orthogonal analysis was performed to test the linear and quadratic effects of chondroitin and glucosamine sulfate levels. Glucosamine sulfate reduced the number of monocytes linearly, by 42 days (p = 0.0399). There was an interaction effect between the sulfates on total white blood cells (p = 0.0099) and lymphocytes (p = 0.0004) by 21 days. Chickens supplemented with 0.10% chondroitin sulfate showed a linear increase in white blood cells (p = 0.0287) and lymphocytes (p = 0.0144) with the addition of glucosamine sulfate. Chondroitin sulfate supplementation increased serum albumin linearly (p = 0.0099) and TSP quadratically (p = 0.0140), by 21 days. Glucosamine sulfate induced a quadratic response (p < 0.05) in albumin by 42 days, with the lowest value found with the inclusion of 0.06%. Glucosamine sulfate reduced chlorides linearly (p = 0.0237) by 21 days and increased calcium linearly (p = 0.0012) by 42 days. The interaction between sulfates influenced (p < 0.05) total calcium by 21 days, ionic calcium by 21 and 42 days, and phosphorus, chlorides, and sodium by 42 days. Supplementation with chondroitin and glucosamine sulfates in the broilers' diet favored their immune system and mineral metabolism, increasing serum concentrations of calcium, phosphorus, and sodium.(AU)

Objetivou-se avaliar a hematologia e a bioquímica sérica de frangos de corte suplementados com sulfatos de condroitina e de glucosamina na ração. Foi conduzido um experimento em delineamento inteiramente casualizado, em esquema fatorial 3 x 3 (três níveis de sulfato de condroitina: 0; 0,05 e 0,10%; e três níveis de sulfato de glucosamina: 0; 0,15 e 0,30%), cada tratamento com seis repetições de 30 aves. Foram avaliadas as variáveis de hematologia (hemácias, hemoglobina, hematócrito, proteínas plasmáticas totais [PPT], trombócitos, leucócitos, eosinófilos, monócitos, heterofilos e linfócitos) e bioquímica sérica (proteínas séricas totais [PST], albumina, globulinas, aspartato aminotransferase [AST], gama glutamiltransferase [GGT], fosfatase alcalina [FA], cálcio total, cálcio iônico, fósforo, sódio, potássio e cloretos) aos 21 e 42 dias. Os dados foram submetidos à análise de variância. Quando as médias diferiram significativamente pelo teste F, a análise ortogonal foi realizada para testar os efeitos lineares e quadráticos dos níveis dos sulfatos de condroitina e de glucosamina. Observou-se efeito linear decrescente (p = 0,0399) do sulfato de glucosamina na quantidade de monócitos aos 42 dias. Houve interação dos sulfatos para leucócitos totais (p = 0,0099) e linfócitos (p = 0,0004) aos 21 dias. Frangos suplementados com 0,10% de sulfato de condroitina mostraram um aumento linear dos leucócitos (p = 0,0287) e dos linfócitos (p = 0,0144) com a inclusão de sulfato de glucosamina. A suplementação com sulfato de condroitina aumentou linearmente (p = 0,0099) a albumina sérica e afetou de forma quadrática (p = 0,0140) as PST aos 21 dias. O sulfato de glucosamina demonstrou um efeito quadrático (p < 0,05) sobre a albumina aos 42 dias, o menor valor foi encontrado para a inclusão de 0,06%, respectivamente. O sulfato de glucosamina reduziu linearmente (p = 0,0237) os cloretos aos 21 dias e aumentou linearmente (p = 0,0012) o cálcio total aos 42 dias. Verificouse interação (p < 0,05) dos sulfatos para cálcio total aos 21 dias, cálcio iônico aos 21 e 42 dias e para fósforo, cloretos e sódio aos 42 dias. A suplementação com os sulfatos de condroitina e de glucosamina na ração de frangos de corte favoreceram o sistema imune e o metabolismo de minerais, com aumento nas concentrações séricas de cálcio, fósforo e sódio.(AU)

Hematological parameters in endurance horses pre and post 120 km race / Parâmetros hematológicos em cavalos de enduro pré e pós prova de 120 km

The endurance discipline has the shortest history in Bulgaria compared with other disciplines of equestrian sports. Endurance competitions are held over distances from 40 km to 160 km. The present study focused on the effect of exercise on horses over a distance of 120 km. Changes in the following hematological parameters were investigated:Leukocytes (WBC, g/l); Erythrocytes (RBC, T/l); Platelets (PLT, g/l); Hemoglobin (Hb, g/l); Hematocrit (HCT,%); Mean corpuscular volume(MCV, fl); Mean corpuscular hemoglobin(MCH, pg); Mean cell hemoglobin concentration(MCHC, g/l), Leukogram (Eos; Bas; Neu; Lym; Mon,%) as well as some electrolytes and hormone concentration. The study aimed to establish the changes in these indicators' values before and after the competition. Analysis of the haemogram showed a significant increase in the mean values of 4 of the indicators under study. No significant differences were established in MCV, MCH and MCHC. A decrease was found in the number of Lym, Eos, and Mon and a significant increase in Neu after the competition. The concentration of electrolytes (Ca, Na and K) in the blood serum decreased, and the levels of CK and LDH significantly increased.(AU)

A disciplina de resistência tem a história maiscurta na Bulgária em comparação com outras disciplinas de esportes equestres. As competições de resistência são realizadas em distâncias de 40 km a 160 km. O presente estudo focou no efeito do exercício em cavalos em uma distância de 120 km. Foram investigadas alterações nos seguintes parâmetros hematológicos: Leucócitos (g/l); Eritrócitos (T/l); Plaquetas (g/l); Hemoglobina (g/l); Hematócrito (%); Volume corpuscular médio (VCM, fl); Hemoglobina corpuscular média (HCM, pg); Concentração de hemoglobina corpuscular média(CHCM, g/l), Leucograma (Eos; Bas; Neu; Lin; Mon,%), bem como alguns eletrólitos e concentração hormonal. O estudo teve como objetivo estabelecer as mudanças nos valores desses indicadores antes e depois da competição. A análise do hemograma mostrou um aumento significativo nos valores médios de 4 dos indicadores estudados. Não foram encontradas diferenças significativas no VMC, HCM e CHCM. Foi encontrada uma diminuição no número de Lin, Eos e Mon e um aumento significativo em Neu após a competição. A concentração de eletrólitos (Ca, Na e K) no soro sanguíneo diminuiu e os níveis de Creatina Quinase (CK) e Lactato Desidrogenase (LDH) aumentaram significativamente.(AU)

Feline leishmaniosis: hematological and biochemical analysis / Leishmaniose felina: análises de hematologia e bioquímica

One hundred and sixty-six cats from two animal shelters were subjected to enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence antibody test (IFAT), conventional polymerase chain reaction (cPCR), quantitative PCR (qPCR) and parasitological tests (PA) for the diagnosis of Leishmania spp. Among them, 15% (25/166), 53.6% (89/166), 3.6% (06/166) and 1.8% (03/166) were positive by ELISA, IFAT, both PCRs and PA, respectively. The sequencing of ITS-1 PCR amplicons revealed a 100% match with Leishmania infantum. After the Leishmania spp. survey, 12 cats were selected and divided into two groups for clinical, hematological, and biochemical analysis: six L. infantum positive cats (G1) and six Leishmania spp. negative cats (G2). All the cats were negative for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV). A statistical analysis indicated significantly low platelet counts and significant hyperproteinemia associated with hypoalbuminemia in positive cats (p<0.05). Our results suggest that in endemic areas, cats with clinical signs of feline leishmaniosis (such as skin lesions, weight loss and/or enlarged lymph nodes) and that exhibit hematological and biochemical changes, such as low platelet counts and hyperproteinemia with hypoalbuminemia, should be tested for Leishmania spp. infection.(AU)

Cento e sessenta e seis gatos de dois abrigos foram submetidos ao diagnóstico de Leishmania spp. por ensaio imunoenzimático (ELISA), imunofluorescência indireta (RIFI), reação em cadeia pela polimerase convencional (cPCR) e quantitativa (qPCR) e métodos parasitológicos (PA). Destes, 15% (25/166), 53,6% (89/166), 3,6% (06/166) e 1,8% (03/166) foram positivos por ELISA, RIFI, as duas PCRs e PA, respectivamente. O sequenciamento dos produtos amplificados da PCR ITS-1 foi 100% idêntico à Leishmania infantum. Após o inquérito, 12 gatos foram selecionados para compor dois grupos para análises de hematologia e bioquímica: 6 gatos positivos para L. infantum (G1) e 6 gatos Leishmania spp. negativos (G2). Todos os gatos foram negativos para o vírus da imunodeficiência felina (FIV) e o da leucemia felina (FeLV). Foi observada uma diminuição na contagem de plaquetas e uma hiperproteinemia e hipoalbuminemia significativas em gatos positivos (p<0,05). Esses resultados sugerem que, em áreas endêmicas, os gatos com sinais clínicos de leishmaniose felina (tais como lesões dermatológicas, perda de peso e/ou linfonodos aumentados), associados a alterações hematológicas e bioquímicas, como contagem reduzida de plaquetas e hiperproteinemia com hipoalbuminemia, devem ser testados para leishmaniose felina.(AU)

A preliminary study on devising a hematological formula for estimation of hemoglobin from packed cell volume in beetal goats / [Um estudo preliminar sobre a elaboração de uma fórmula hematológica para a estimativa da hemoglobina do volume de células embaladas em cabritos beetal]

The study was devised with the aim to evaluate the relationship between hemoglobin (Hb) concentration and Packed Cell Volume (PCV) in beetal goats being reared under pastoralism. It also aims to devise a hematological formula for estimation of Hb from PCV. Female (n=59) and male goats (n=41) were bled for PCV determination through microhematocrit method, and Hb estimation through Sahli's hemoglobinometer (HbD) as well as through calculation being 1/3rd of PCV (HbC). The HbD and HbC were statistically non-significant (P≥0.05) for male and female beetal goats. Overall, significantly (P≤0.01) positive correlation coefficient was noticed between HbD and PCV, and between HbD and HbC (r=0.75; adjusted r-square=0.57). As the overall model predicted that 57% variability in HbD could be deduced from PCV, hence, in order to enhance the prediction probability, the regression equation i.e. Hb concentration= 0.24(PCV) +1.5 was utilized to deduce corrected hemoglobin (CHb). The comparison of this CHb with HbD gave a non-significant (P≤0.05) difference. Similarly, linear regression of CHb with PCV gave a 99% prediction. We accordingly recommend a simplified pen-side hematological formula for deducing Hb concentration from PCV viz. Hb concentration= 0.24(PCV) +1.5 for beetal goats instead of its calculation as one-third of PCV.

O estudo foi elaborado com o objetivo de avaliar a relação entre a concentração de hemoglobina (Hb) e o volume de células embaladas (PCV) em caprinos beetal em pastoreio. O objetivo também é elaborar uma fórmula hematológica para a estimativa da hemoglobina de PCV. Cabras fêmeas (n=59) e machos (n=41) foram sangrados para determinação da PCV através do método do microhematócrito, e a estimativa de Hb através do hemoglobinômetro Sahli (HbD), bem como através do cálculo sendo 1/3 do PCV (HbC). O HbD e HbC foram estatisticamente não significativos (P≥0.05) para caprinos machos e fêmeas beetal. De modo geral, foi observado um coeficiente de correlação positiva (P≤0.01) entre HbD e PCV, e entre HbD e HbC (r=0,75; r-quadrado ajustado=0,57). Como o modelo geral previa que 57% de variabilidade em HbD poderia ser deduzida do PCV, portanto, para aumentar a probabilidade de predição, a equação de regressão i.e. concentração de Hb= 0,24(PCV) +1,5 foi utilizada para deduzir a hemoglobina corrigida (CHb). A comparação desta CHb com HbD deu uma diferença não significativa (P≤0.05). Da mesma forma, a regressão linear de CHb com PCV deu uma previsão de 99%. Assim, recomendamos uma fórmula hematológica simplificada do lado da caneta para deduzir a concentração de Hb do PCV, ou seja, concentração de Hb= 0,24(PCV) +1,5 para cabras beetal em vez de seu cálculo como um terço do PCV.

Nutrient status, hematological and blood metabolite profile of mid-lactating dairy cows during wet and dry seasons raised under Indonesian tropical environmental conditions

This study was conducted to determine the nutrient status, changes in the hematological and selected blood metabolites profile of mid-lactating dairy cows during wet and dry seasons under Indonesia's tropical environment. Forty mid-lactating FH cows were selected from the Livestock Farm Complex (Dairy Community) in Yogyakarta, with an average body weight of 421.77±28.60 kg and 1st to 3rd lactation. They were housed in a semi-open housing system with concrete flooring covered with rubber mats and provided with feeders and drinkers. They were fed twice daily, and drinking water was given ad libitum. Measurements were made on the intakes of feed (and nutrients). The variables measured were nutrient intakes, blood hematology, and metabolites profile and measured over two seasons, namely wet and dry seasons. The results of the measurements made were compared using independent t-test analysis. The result indicated that intake of CP, RLYM, RNEUT, NEUT, RBC, HGB, MCV, MCHC, MPV, albumin, urea nitrogen, and total protein was differed significantly (P < 0.05) between wet and dry seasons, respectively. It was concluded that the nutrient status of mid-lactating dairy cows in the wet season was higher than during the dry season, especially the intake of CP. In the wet season, it has a positive effect on the basic hematological parameters.(AU)

Case Report: Extrapulmonary Manifestations of COVID-19 and Dengue Coinfection.

The risk of coronavirus disease 2019 (COVID-19) and dengue coinfection is increased in tropical countries; however, the extrapulmonary clinical manifestations have not been fully characterized. We report a 42-year-old woman whose clinical manifestations began with fever, diarrhea, headache, chest pain, myalgia, odynophagia, and arthralgia. Despite mild respiratory symptoms and normal chest computed tomography scan results, she was diagnosed with real-time reverse-transcription polymerase chain reaction (RT-PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Because she had erythema and petechiae with a decreased platelet count, the dengue NS1 antigen and anti-dengue IgM/IgG test were performed, and the Centers for Disease Control and Prevention RT-PCR assay detected the dengue virus serotype 1 infection. Additionally, increased liver enzyme serum levels were found in the patient, who later developed hepatomegaly. Hence, the mechanism of hepatic pathology associated with SARS-CoV-2 and dengue coinfection needs further research.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Caracterización del paciente con anemia de células falciformes, Hospital Escuela Universitario, 2016-2017 / Characterization of the patient with Sickle Cell Anemia, University School Hospital, 2016­2017

La anemia de células falciformes es un trastorno autosómico recesivo, causado por una mutación genética que codifica la cadena ß de globina. Objetivo: caracterizar al paciente con diagnóstico de anemia de células falciformes atendidos en el Servicio de Hematología y salas de hospitalización del Hospital Escuela Universitario, período enero 2016 -junio 2017. Material y métodos: estudio retrospectivo, descriptivo transversal. Se incluyen 72 historias clínicas de pacientes con diagnóstico de anemia de células falciformes. Se definieron las variables sobre el último episodio documentado, aspectos sociodemográficos, antecedentes, presentación clínica y valores de laboratorio. Resultados: la media para la edad fue 29.7+/-13; hombres 42(58.3%) y mujeres 30(41.6%). De ellos 46(63.9%) procedían de Francisco Morazán.; 38(52.8%) presentaron trombocitosis y 32(44.4%) tuvieron hiperbilirrubinemia al ingreso; 30(41.7%) presentaron complicación relacionada con crisis vaso-oclusiva sin fallecimientos, 23(31.9%) pacientes fueron atendidos en consulta externa y 49(68.1%) fueron hospitalizados. Conclusión: la mayoría de los pacientes con diagnóstico de anemia de células falciformes eran adultos jóvenes, de predominio masculino, manejados con hidroxiurea, opioides y antibioticoterapia, presentándose como crisis vaso-oclusiva y/o crisis dolorosa, sin casos de mortalidad...(AU)

Evaluación preliminar de estándares de calidad en el Instituto de Hematología e Inmunología / Preliminary evaluation of quality standards in the Institute of Hematology and Immunology

Introducción: El Instituto de Hematología e Inmunología (IHI), desde el año 2002 comenzó a capacitar a todo el personal en Sistema de Gestión de la Calidad y paulatinamente avanzó en la documentación requerida hasta lograr una política y un Programa de Garantía de la Calidad, basado en normativas nacionales, cumpliendo con el anexo Programa de Perfeccionamiento continuo de la calidad de los servicios hospitalarios. Objetivo: Realizar una evaluación preliminar de estándares de calidad en el IHI, aplicando la última versión del Manual de Acreditación, para solicitar la acreditación hospitalaria. Métodos: Se realizó una evaluación parcial mediante auditorías internas al 90 por ciento de las áreas y se desarrollaron actividades para cumplir con lo solicitado por la Junta Nacional de Acreditación en Salud. Se emplearon diversos métodos, como aplicación de listas de verificación, cursos de capacitación y superación, observación in situ de evidencias objetivas, entrevistas, encuestas y revisión de documentos. Resultados: De los 18 servicios auditados se obtuvo del Estándar Centrado en la Atención y Seguridad a Paciente el cumplimiento del 77 por ciento de los elementos a evaluar; dl Estándar Docencia e Investigación, se cumplió el 88 por ciento y del Estándar Gestión y Seguridad Hospitalaria se cumplió el 87 por ciento de los elementos auditados. Conclusiones: La aplicación preliminar de los estándares de calidad en el IHI ha generado más de 60 documentos, lo cual indica el desarrollo progresivo en esta actividad, además de capacitar al personal en temas de calidad y conocer el estado de satisfacción de pacientes y prestadores de servicios(AU)

Introduction: The Institute of Hematology and Immunology (IHI) had begun training all its personnel in the Quality Management System since 2002 and it gradually progressed in the required documentation until achieving a policy and a Quality Assurance Program, based on national regulations, complying with the annex Program of continuous improvement of the quality of hospital services. Objective: To carry out a preliminary evaluation of quality standards in the IHI, applying the latest version of the Accreditation Manual, in order to request hospital accreditation. Methods: A partial evaluation was carried out through internal audits to 90 percent of the areas and activities were developed to comply with the requirements of the National Health Accreditation Board. Various methods were used, such as: application of checklists, training and improvement courses, on-site observation of objective evidence, interviews, surveys and document review. Results: Of the 18 audited services, compliance with 77 percent of the elements to be evaluated was obtained from the Standard centered on Patient Care and Safety; 88 percent of the Standard related to Teaching and Research was fullfilled and the Hospital Management and Safety Standard achieved 87 percent of the audited elements. Conclusion: The preliminary application of the quality standards in the IHI has generated more than 60 documents. It indicates the progressive development of this activity and at the same time allows for the training of the staff on quality issues and gives us the possibility of knowing the satisfaction status of patients and service providers(AU)

Moral Distress Assessment in the Nursing Team of a Hematology-Oncology Sector.

OBJECTIVE: To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology. METHOD: A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used. RESULTS: Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively. CONCLUSION: It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

Moral Distress Assessment in the Nursing Team of a Hematology-Oncology Sector / Evaluación del Sufrimiento Moral en el equipo de enfermería de un sector de Hemato-Oncología / Avaliação do Sofrimento Moral na equipe de enfermagem de um setor de Hemato-Oncologia

ABSTRACT Objective: To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology. Method: A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used. Results: Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively. Conclusion: It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

RESUMEN Objetivo: Identificar la frecuencia e intensidad del Sufrimiento Moral y analizar las asociaciones entre el Sufrimiento Moral y las características sociodemográficas y laborales del equipo de enfermería de un sector de Hemato-Oncología. Método: Estudio transversal, realizado con 46 profesionales de enfermería de un sector de Hemato-Oncología de una institución hospitalaria de Rio Grande do Sul, por medio de la aplicación de la escala Moral Distress Scale - Versión brasileña. Se empleó, en el análisis de los datos, estadística descriptiva y pruebas de asociación no paramétricas. Resultados: Se verificó una media de intensidad del Sufrimiento Moral de 3,27 (DP = 1,79) y la frecuencia de 1,72 (DP = 1,02) en ese equipo. El Sufrimiento Moral de mayor intensidad y frecuencia fueron referentes a la negación del papel de la enfermería como abogada del paciente y el irrespeto a la autonomía del paciente, respectivamente. Conclusión: Se sugiere mayor espacio de discusión entre profesionales, equipo multiprofesional y jefaturas, para que sean proporcionadas adecuadas condiciones de actuación y comunicación.

RESUMO Objetivo: Identificar a frequência e intensidade do Sofrimento Moral, e analisar as associações entre Sofrimento Moral e características sociodemográficas e laborais da equipe de enfermagem de um setor de Hemato-Oncologia. Método: Estudo transversal, realizado com 46 profissionais de enfermagem de um setor de Hemato-Oncologia de uma instituição hospitalar do Rio Grande do Sul, por meio da aplicação da escala Moral Distress Scale - Versão brasileira. Empregou-se, na análise dos dados, estatística descritiva e testes de associação não paramétricos. Resultados: Verificou-se média de intensidade do Sofrimento Moral de 3,27 (DP = 1,79) e frequência de 1,72 (DP = 1,02) nessa equipe. O Sofrimento Moral de maior intensidade e frequência foram referentes à negação do papel da Enfermagem como advogada do paciente e o desrespeito à autonomia do paciente, respectivamente. Conclusões: Sugere-se maior espaço de discussão entre profissionais, equipe multiprofissional e chefias, para que sejam proporcionadas adequadas condições de atuação e comunicação.

Mass spectrometry and proteomics in hematology.

Mass spectrometry-based techniques now enable the unbiased identification of proteins in complex mixtures including proteins isolated from cells and tissues. These powerful tools permit near-complete annotation of proteins expressed in cells, tissues or organs. Further, these techniques permit the interrogation of the numerous posttranslational modifications that govern cell-specific responses to signaling cues and underlie the functional heterogeneity of cellular composition and contribute to biological complexity. Parallel developments in technologies such as mass cytometry and multicolor ion-beam imaging which permit multi-parameter detection of numerous proteins at the single-cell and in situ level respectively, are poised to radically impact our understanding of the functional and translational importance of proteins in hematologic conditions. Importantly, the field of proteomics is poised to realize the immensely powerful opportunities in integration with genomic information that is being discovered at an unprecedented pace for many hematologic conditions.

Stability of complete blood count in different storage conditions using the ABX PENTRA 60 analyzer.

INTRODUCTION: Sample stability is essential to obtain reliable results in the clinical laboratory. This study was conducted to investigate the reliability of hematological parameters using ABX Pentra 60 in samples stored for up to 72 hours at different temperatures. METHODS: A total of 651 blood samples were analyzed at different analysis times: 2, 24, 48, and 72 hours and forms and storage: room temperature (25°C) and at 4°C. The imprecision of the results was evaluated by the analytical coefficient of variation (CVa%) obtained by the typical error (TE) and Kruskal-Wallis analysis, to compare the averages. The reliability of the results was evaluated by the CVa (%) within the maximum allowable analytical variation and by the difference of means of the results in relation to the baseline sample (2 hours). RESULTS: Red blood count, hemoglobin, and MCH parameters showed stability up to 72 hours at room temperature and at 4°C. The other complete blood count parameters showed imprecision results emitted by the ABX Pentra 60 from 24 hours of sample storage, independent of the storage temperature. In addition, there were significant oscillations in the mean values, particularly for the samples stored at room temperature, with the exception of platelet parameters that exhibited mean changes also at 4°C. CONCLUSION: The results demonstrate the importance of the clinical analyst's knowledge about the behavior of the CBC parameters over time under different storage conditions, and mainly the imprecision of the hematological equipment used, for the suitable interpretation of the results.

Haematological reference of snakes: Amazon tree boa (Corallus hortulanus, Linnaeus, 1758) and Burmenese Python (Python bivittatus, Kuhl, 1820) in captive / Parâmetros hematológicos das serpentes: suaçuboia (Corallus hortulanus, Linnaeus, 1758) e píton birmanesa (Python bivittatus, Kuhl, 1820) em cativeiro

Hematology has become important for making clinical diagnoses in snakes because maintenance techniques in captivity have been improving and increasing their life expectancy. The emergence of diseases in captivity requires the creation of parameters to understand the species in their healthy state. The possible association between the onset of neoplasia, immunosuppression, and viral infection are also important factors to consider. Thus, hematology is a fundamental tool for observing the responses of animals to diseases and treatments. The present study aims to study hematology between two species of snakes and compare the profiles observed with published results. Blood samples were collected from 16 male and female snakes: seven Corallus hortulanus from the family Boidae and nine Python bivittatus from the family Pythonidae belonging to the Biological Museum of the Butantan Institute, São Paulo, Brazil. Complete blood count results including blood smear, total erythrocyte count, leukocytes, and differential leukocyte count were evaluated. The data obtained in this study could help with the diagnosis, the treatment of snakes in captive conditions and in of nature conservation programs.(AU)

A hematologia das serpentes tem se tornado algo de grande importância para o diagnóstico clínico, visto que as técnicas de manutenção em cativeiro vêm aumentando a expectativa de vida. O surgimento de doenças em cativeiro leva à necessidade de criar parâmetros para conhecer as espécies em seu estado hígido. A possível associação entre o surgimento de neoplasias, imunossupressão e infecção viral também é um importante fator a ser considerado. Assim, a hematologia é uma ferramenta fundamental para se observarem as respostas dos animais diante das doenças e dos tratamentos. Nesse contexto, o presente estudo tem como objetivo o estudo hematológico entre duas espécies de serpentes e a comparação dos perfis encontrados com a literatura atual. Foi coletado sangue de 16 serpentes de ambos os sexos da família Boidae: sete Corallus hortulanus, e da família Pythonidae: nove Python bivittatus, pertencentes ao Museu Biológico do Instituto Butantan, São Paulo, Brasil. Foram avaliados o hemograma completo com esfregaço sanguíneo, a contagem total de eritrócitos, os leucócitos e a contagem diferencial de leucócitos. Os dados obtidos neste estudo poderão auxiliar no diagnóstico e no tratamento de serpentes em cativeiro e em programas de conservação da natureza.(AU)

Haematological reference of snakes: Amazon tree boa (Corallus hortulanus, Linnaeus, 1758) and Burmenese Python (Python bivittatus, Kuhl, 1820) in captive / Parâmetros hematológicos das serpentes: suaçuboia (Corallus hortulanus, Linnaeus, 1758) e píton birmanesa (Python bivittatus, Kuhl, 1820) em cativeiro

Hematology has become important for making clinical diagnoses in snakes because maintenance techniques in captivity have been improving and increasing their life expectancy. The emergence of diseases in captivity requires the creation of parameters to understand the species in their healthy state. The possible association between the onset of neoplasia, immunosuppression, and viral infection are also important factors to consider. Thus, hematology is a fundamental tool for observing the responses of animals to diseases and treatments. The present study aims to study hematology between two species of snakes and compare the profiles observed with published results. Blood samples were collected from 16 male and female snakes: seven Corallus hortulanus from the family Boidae and nine Python bivittatus from the family Pythonidae belonging to the Biological Museum of the Butantan Institute, São Paulo, Brazil. Complete blood count results including blood smear, total erythrocyte count, leukocytes, and differential leukocyte count were evaluated. The data obtained in this study could help with the diagnosis, the treatment of snakes in captive conditions and in of nature conservation programs.(AU)

A hematologia das serpentes tem se tornado algo de grande importância para o diagnóstico clínico, visto que as técnicas de manutenção em cativeiro vêm aumentando a expectativa de vida. O surgimento de doenças em cativeiro leva à necessidade de criar parâmetros para conhecer as espécies em seu estado hígido. A possível associação entre o surgimento de neoplasias, imunossupressão e infecção viral também é um importante fator a ser considerado. Assim, a hematologia é uma ferramenta fundamental para se observarem as respostas dos animais diante das doenças e dos tratamentos. Nesse contexto, o presente estudo tem como objetivo o estudo hematológico entre duas espécies de serpentes e a comparação dos perfis encontrados com a literatura atual. Foi coletado sangue de 16 serpentes de ambos os sexos da família Boidae: sete Corallus hortulanus, e da família Pythonidae: nove Python bivittatus, pertencentes ao Museu Biológico do Instituto Butantan, São Paulo, Brasil. Foram avaliados o hemograma completo com esfregaço sanguíneo, a contagem total de eritrócitos, os leucócitos e a contagem diferencial de leucócitos. Os dados obtidos neste estudo poderão auxiliar no diagnóstico e no tratamento de serpentes em cativeiro e em programas de conservação da natureza.(AU)

Comparación del recuento celular entre un método manual y un contador automatizado en líquidos de derrame / Comparison of manual microscope method and an automated cell count in serous fluids / Comparação da recontagem celular entre um método manual e um contador automatizado em líquidos de derrame

El objetivo del trabajo consistió en comparar el recuento celular total en los líquidos de derrame de cavidades serosas entre el método automatizado empleado en hematología y el método manual en hemocitómetro. Se procesaron 107 muestras: 45 líquidos ascíticos (LA) y 62 líquidos pleurales (LP) a los que se les realizó el recuento celular en cámara de Neubauer y en contador hematológico Sysmex XT 1800i. Se obtuvieron los siguientes resultados: 1) Regresión lineal: los coeficientes de correlación indicaron una alta correlación entre ambos métodos (LA r2: 0,999; p<0,0001 y LP r2: 0,997; p<0,0001). 2) Bland-Altman: El análisis de las figuras muestra una excelente concordancia entre ambos métodos. El error sistemático fue 51 para los LA y 97 para los LP, por lo que estos valores son despreciables dado el valor diagnóstico de los datos. Los resultados demuestran que los métodos son comparables entre sí y, por ende, se puede remplazar el recuento manual por el automatizado, de demostrada eficiencia y exactitud. Sin embargo, todos los líquidos requieren una observación al microscopio óptico previa al procesamiento por el contador hematológico, donde se apreciará la presencia de agrupamientos celulares como, por ejemplo, células neoplásicas en disposición glandular que dificultan el análisis por parte del equipo o la interpretación del resultado.

The purpose of this work was to compare the total cell count in liquids serous cavities between the automated method used in hematology and the manual method hemocytometer. A total of 107 samples were processed: 45 ascites fluids (LA for its name in Spanish) and 62 pleural fluids (LP for its name in Spanish). The cells were counted in improved Neubauer counting chamber and hematology analyzer Sysmex XT 1800i. The following results were obtained: 1) Linear Regression correlation coefficients indicated a high correlation between the two methods (LA r2: 0.999; p<0.0001 LP r2: 0.997; p<0.0001). 2) Bland-Altman analysis graphics showed excellent agreement between both methods. The systematic error was 51 for LA and 97 for LP; these values are insignificant considering the diagnostic value of the data. he results demonstrate that the methods are comparable and therefore can replace the manual counting by the automated method with proven efficiency and accuracy. However, all fluids require observation by optical microscope before being processed by the hematology analyzer, where the presence of cell clusters such as neoplastic cells in glandular disposition will be appreciated, which hinder the analysis by the equipment or interpretation of results.

O objetivo do trabalho consistiu em comparar a contagem total de células em líquidos de derrame de cavidades serosas entre o método automatizado utilizado em hematologia e o método manual em hemocitômetro. Foram processadas 107 amostras: 45 líquidos ascíticos (LA) e 62 líquidos pleurais (LP) nos quais se realizou a recontagem celular na câmara de Neubauer e no contador hematológico Sysmex XT 1800i. Foram obtidos os seguintes resultados: 1) Regressão linear: os coeficientes de correlação indicaram uma alta correlação entre ambos os métodos (LA r2: 0,999; p<0,0001 e LP r2: 0,997; p<0,0001). 2) Bland-Altman: A análise dos Figuras mostra uma excelente concordância entre ambos os métodos. O erro sistemático foi 51 para os LA e 97 para os LP, resultando estes valores desprezáveis dado o valor diagnóstico dos dados. Os resultados demonstram que os métodos são comparáveis entre si e, portanto, pode ser substituída a contagem manual pela automatizada, de eficiência e exatidão demonstradas. Entretanto, todos os líquidos requerem observação no microscópio óptico prévia ao processamento pelo contador hematológico. Nesse momento se apreciará a presença de agrupamentos celulares como, por exemplo, células neoplásicas em disposição glandular que dificultam a análise por parte da equipe ou a interpretação do resultado.